Duan Yang, Wang Yiwen, Zhang Min, Li Zhi, Chen Lei, Miao Hao, Pei Siyu, Lu Yuan, Wang Zhirong
Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
Front Physiol. 2022 May 24;13:898659. doi: 10.3389/fphys.2022.898659. eCollection 2022.
The impairment of microvascular injury on prognosis has increasingly drawn extensive awareness along with the high morbidity and mortality of ST-segment elevation myocardial infarction (STEMI) over recent years. The prognostic significance of computational pressure-fluid dynamics applied to index of microcirculatory resistance, derived from coronary angiography (CPFD-caIMR) in microvascular injury evaluation of STEMI patients remained inconclusive. A total of 213 patients who met the inclusion criteria were selected retrospectively from 1003 STEMI patients from February 2018 to February 2020. Propensity score matching (PSM) was thereafter finished. CPFD-caIMR of all patients was obtained off-line using the software (FlashAngio, Rainmed Ltd., Suzhou, China) after PPCI. The primary endpoint was to compare the CPFD-caIMR and the incidence of major adverse cardiovascular events (MACEs) between drug-coated balloons (DCB) and drug-eluting stents (DES) groups. The correlation between CPFD-caIMR and MACEs was analyzed, and the prognosis of patients with STEMI was evaluated by CPFD-caIMR by multivariate regression analysis. Totally 213 STEMI patients with successful primary percutaneous coronary intervention (PPCI) were included, of whom 84 patients accepted DCB and 129 patients accepted DES respectively. Baseline characteristics and CPFD-caIMR were comparable between DCB and DES groups after PSM (62 patients in each group). CPFD-caIMR was not significantly different between two groups (DES vs. DCB: mean difference: 2.26, 95% CI -4.05 to 8.57, = 0.45), and so was it when re-grouped by whether CPFD-caIMR > 40U or not (DES vs. DCB: 34.17% vs. 27.16%, = 0.29). After a follow-up of 1 year, more MACEs occurred in DES group than DCB group (relative risk: 2.50, 95% CI 1.04 to 6.02, = 0.04). The predictors of MACEs by multi-variate analysis found that, only time from symptom to balloon ( = 0.03) and time from door to balloon ( < 0.01) were independent predictors of MACEs, independent of treatment with DCB or DES intervention. Furthermore, CPFD-caIMR > 40U became an independent predictor of the combined events including cardiovascular deaths or heart failure readmission irrespective of PSM (odds ratio: 4.07, 95% CI: 1.06 to 7.66, = 0.04). CPFD-caIMR was a promising method for prognosis, which can predict CV death or heart failure readmission in STEMI patients. DCB was a possible strategy in PPCI of STEMI patients, not inferior to DES based on microvascular injury evaluated by CPFD-caIMR.
近年来，随着ST段抬高型心肌梗死（STEMI）的高发病率和死亡率，微血管损伤对预后的影响日益引起广泛关注。应用于微血管阻力指数的计算压力 - 流体动力学（源自冠状动脉造影，CPFD - caIMR）在STEMI患者微血管损伤评估中的预后意义仍不明确。从2018年2月至2020年2月的1003例STEMI患者中回顾性选取了213例符合纳入标准的患者。随后进行倾向评分匹配（PSM）。所有患者在急诊经皮冠状动脉介入治疗（PPCI）后，使用该软件（FlashAngio，苏州润迈德医疗科技有限公司，中国）离线获取CPFD - caIMR。主要终点是比较药物涂层球囊（DCB）组和药物洗脱支架（DES）组之间的CPFD - caIMR及主要不良心血管事件（MACE）的发生率。分析CPFD - caIMR与MACE之间的相关性，并通过多变量回归分析用CPFD - caIMR评估STEMI患者的预后。共纳入213例成功进行急诊经皮冠状动脉介入治疗（PPCI）的STEMI患者，其中84例接受DCB治疗，129例接受DES治疗。PSM后，DCB组和DES组的基线特征及CPFD - caIMR具有可比性（每组62例患者）。两组间CPFD - caIMR无显著差异（DES组与DCB组：平均差异：2.26，95%CI -4.05至8.57，P = 0.45），按CPFD - caIMR是否>40U重新分组时亦是如此（DES组与DCB组：34.17%对27.16%，P = 0.29）。随访1年后，DES组发生的MACE多于DCB组（相对风险：2.50，95%CI 1.04至6.02，P = 0.04）。多变量分析MACE的预测因素发现，仅症状到球囊时间（P = 0.03）和门到球囊时间（P<0.01）是MACE的独立预测因素，与DCB或DES干预治疗无关。此外，无论PSM情况如何，CPFD - caIMR>40U成为包括心血管死亡或心力衰竭再入院在内的联合事件的独立预测因素（比值比：4.07，95%CI：1.06至7.66，P = 0.04）。CPFD - caIMR是一种有前景的预后评估方法，可预测STEMI患者的心血管死亡或心力衰竭再入院。DCB是STEMI患者PPCI中的一种可能策略，基于CPFD - caIMR评估的微血管损伤，其不劣于DES。
